Left atrial-to-aortic assistance with in-line left ventricular venting.

Left atrial-to-aortic assistance (LA-A) has been employed for left ventricular failure (LVF) refractory to intra-aortic balloon counterpulsation. Although clinical success has been reported, LA-A is limited by incomplete left ventricular (LV) decompression. We have developed a method to augment LA-A with an in-line LV apical vent (LA-lv-A). LVF was produced in 12 dogs by ligation of the circumflex coronary artery. Circulatory assistance was established with LA (28-32 Fr), LV apex (12-14 Fr) and femoral artery cannulation and a centrifugal pump. LA-A assistance was compared to LA-lv-A. Left atrial pressure was reduced from 10 +/- 3 torr to 5 +/- 3 torr (p less than 0.001), left ventricular systolic pressure was reduced from 48 +/- 4 torr to 9 +/- 2 torr (p less than 0.001) and left ventricular end-diastolic pressure was reduced from 10 +/- 2 torr to 1 +/- 1 torr (p less than 0.001). We conclude that LA-lv-A results in complete LV decompression. LA-lv-A should be considered as an alternative method for temporary left heart bypass.